Original Article

Supportive Care in Cancer

, Volume 21, Issue 8, pp 2137-2143

Breakthrough febrile neutropenia and associated complications among elderly cancer patients receiving myelosuppressive chemotherapy for solid tumors and lymphomas

  • Alexandre ChanAffiliated withDepartment of Pharmacy, Faculty of Science, National University of SingaporeDepartment of Pharmacy, National Cancer Centre Singapore Email author 
  • , Chee Ping LeeAffiliated withDepartment of Pharmacy, National Cancer Centre Singapore
  • , Joen ChiangAffiliated withDepartment of Pharmacy, National Cancer Centre Singapore
  • , Raymond NgAffiliated withDepartment of Medical Oncology, National Cancer Centre Singapore

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This study evaluated the prevalence, impact and predictive factors for the occurrence of febrile neutropenia (FN) in elderly patients receiving adjuvant myelosuppressive chemotherapy despite primary prophylaxis with G-CSF (breakthrough FN).


This was a single-centre, observational, retrospective cohort study. Elderly cancer patients (≥65 years old) who have received adjuvant chemotherapy with primary prophylaxis using G-CSF from Jan 2008 to Aug 2011 were included. Variables identified by the univariate analysis as being associated with FN were included in a multivariable logistic model to investigate the independence of its association with FN.


One hundred and forty-five patients and 704 cycles of chemotherapy were analyzed in this study, of which majority were Chinese (79.3 %). The median age of the patients was 69 years old (IQR: 66, 74). Majority of these patients were diagnosed with lymphoma (54.5 %), followed by breast cancer (34.5 %) and small cell lung cancer (8.3 %). In total, 24 patients (16.6 %) manifested at least one episode of FN, of which 41.7 % occurred during the first cycle of treatment. Only a minority of FN patients had clinically significant dose delay or reduction (25.0 % and 12.5 %, respectively). After adjustment with confounders (gender, baseline lymphocyte counts and baseline absolute neutrophil counts), patients with ≥2 comorbidities were at higher risk to develop breakthrough FN (AOR = 4.42, 95 %CI: 1.36–14.40, p = 0.014).


Breakthrough FN is prevalent among elderly cancer patients receiving adjuvant chemotherapy despite G-CSF support, particularly among patients with more than two comorbidities.


Elderly Colony stimulating factors Breakthrough febrile neutropenia G-CSF